Pharmacotherapy Treatment Patterns, Outcomes, and Health Resource Utilization Among Patients with Heart Failure with Reduced Ejection Fraction at a U.S. Academic Medical Center

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure with reduced ejection fraction (HFrEF) (n=989). Intervention: Implantable cardiac device vs. No implantable cardiac device. Primary outcome: Presence of triple therapy (β-blocker, ACEI/ARB, and ARA) (OR 2.1, 95% CI 1.3-3.5).

Q: What does this research mean for the field?

Among real-world patients with HFrEF, guideline-directed triple therapy utilization is low at 19%, with an implantable cardiac device being associated with a two-fold increase in odds of receiving triple therapy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Adam P. Bress; Jordan B. King; Diana Brixner; Adrian Kielhorn; Harshali Patel; Juan Maya; Vinson C. Lee; Joseph Biskupiak; Mark Munger

doi:10.1002/phar.1701

February 1, 2016Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy

Pharmacotherapy Treatment Patterns, Outcomes, and Health Resource Utilization Among Patients with Heart Failure with Reduced Ejection Fraction at a U.S. Academic Medical Center

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Key Points

To evaluate clinical characteristics, pharmacotherapy patterns, healthcare resource utilization, and clinical outcomes among patients with heart failure with reduced ejection fraction in a real-world academic medical center.
Retrospective analysis of electronic health record data from the University of Utah Health Care System covering January 1, 2007, through June 30, 2013.
Included N=989 adults with prevalent heart failure and a left ventricular ejection fraction ≤40%, with a mean follow-up of 36 ± 27 months.
Assessed medication adherence, target dose achievement, hospitalization rates, associated medical charges, and predictors of triple therapy using logistic regression.
Prescription rates were 79% for β-blockers, 69% for ACEIs/ARBs, and 29% for ARAs, but target doses were achieved in only 24%, 31%, and 13% of cases, respectively; 19% received triple therapy.
Receipt of triple therapy was negatively associated with older age (multivariate OR 0.768, 95% CI 0.625–0.942) and positively associated with an implantable cardiac device (multivariate OR 2.1, 95% CI 1.3–3.5).
All-cause mortality was 0.12 per person-year, all-cause hospitalizations occurred at 0.44 per person-year (47% for worsening heart failure), and the 30-day readmission rate was 20%.

Study Design

Type

Cohort (n=989)

Multicenter

No

Structured PICO

P

Population

989 adults with prevalent heart failure with reduced ejection fraction (LVEF ≤40%) followed for a mean of 36 months.

E

Exposure

Real-world pharmacotherapy treatment patterns (guideline-directed medical therapy including beta-blockers, ACE inhibitors, ARBs, and aldosterone receptor antagonists)

O

Outcome

Clinical characteristics, pharmacotherapy treatment patterns, resource utilization and associated charges, and morbidity and mortality outcomes

Main Result

Odds Ratio: 2.1 (95% CI 1.3–3.5)

Implication

Real-world data highlights significant ongoing gaps in the implementation and optimal dosing of guideline-directed medical therapy for HFrEF patients, alongside high resource utilization and readmission rates.

Abstract

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Discussion

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Cite This Study

Bress et al. (2016) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=989). Implantable cardiac device vs. No implantable cardiac device was evaluated on Presence of triple therapy (β-blocker, ACEI/ARB, and ARA) (OR 2.1, 95% CI 1.3-3.5).

synapsesocial.com/papers/6aa6a9ed24d99d1b40dd6164 https://doi.org/10.1002/phar.1701

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Pharmacotherapy Treatment Patterns, Outcomes, and Health Resource Utilization Among Patients with Heart Failure with Reduced Ejection Fraction at a U.S. Academic Medical Center

Key Points

Study Design

Structured PICO

Main Result

Implication

Abstract

Discussion

Cite This Study

Pharmacotherapy Treatment Patterns, Outcomes, and Health Resource Utilization Among Patients with Heart Failure with Reduced Ejection Fraction at a U.S. Academic Medical Center

Key Points

Study Design

Structured PICO

Main Result

Implication

Abstract

Discussion

Cite This Study

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